Provider Demographics
NPI:1245612688
Name:ST MARYS HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:ST MARYS HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALUYUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-248-6900
Mailing Address - Street 1:8945 W POST RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2431
Mailing Address - Country:US
Mailing Address - Phone:702-248-6900
Mailing Address - Fax:702-258-7301
Practice Address - Street 1:8945 W POST RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2431
Practice Address - Country:US
Practice Address - Phone:702-248-6900
Practice Address - Fax:702-258-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1306061080251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1306061080Medicaid